Depression among retired football players: Levels mirror the general population, but pain compounds symptoms

University of Michigan Health System study is based on extensive survey of retired NFL players

ANN ARBOR, MI – As the sports world prepares for this weekend’s National Football League draft and the excitement of promising young players entering the league, a new study from the University of Michigan Health System highlights the issues faced at the other end of the career spectrum, after players retire.

The study for the first time quantifies the pain and depression experienced by retired NFL players, and assesses other health issues that are impacted by pain and depression.

“We found that retired professional football players experience levels of depressive symptoms similar to those of the general population, but the impact of these symptoms is compounded by high levels of chronic pain,” says lead author Thomas L. Schwenk, M.D., the George A. Dean, M.D. Chair and Professor of Family Medicine at the U-M Health System and associate director of the U-M Depression Center.

To obtain the data, researchers sent surveys to 3,377 members of the NFL Players Association, Retired Players Section. Of the 1,594 people who responded, the prevalence of moderate to severe depression was nearly 15 percent, very similar to the prevalence in the general public. But the frequency with which the retired players reported problems with pain – nearly half the people in the study – puts them at significant additional risk for depression and associated difficulties, Schwenk says.

More than half had high scores in pain, depression or both. About 11 percent had high scores in both areas, 37 percent had high pain scores and low depression scores, and 4 percent had low depression scores and high pain scores. The remaining 48 percent had low scores in both categories.

In addition to the strong link between depression and pain, the relationship between these conditions and other issues also was notable, says co-author Eric Hipple, a retired Detroit Lions quarterback who now is outreach coordinator for the U-M Depression Center.

For example, those responding to the survey whose scores indicated moderate to severe depression were 11 times more likely to report trouble sleeping than those rated as not depressed or mildly depressed.

Similarly, those in the moderate-to-severe depression category were nearly eight times more likely to report a loss of fitness and lack of exercise, and seven times more likely to report financial difficulties. Retired players who scored high in the pain categories also tended to have more problems in these areas. And respondents who rated as moderately to severely depressed were much more likely to have problems with a lack of social support or friendships, the use of prescribed medication, alcohol or other drugs, and trouble with the transition to life after football.

Participants in the survey also reported barriers to seeking help for their problems, including a preference to deal with their issues using spiritual means or through family and friends, lack of insurance coverage, and a lack of recognition that these problems were important. Many said they would feel weak or embarrassed if they sought help.

“What our research tells us is that this population of retired professional athletes would benefit from a proactive educational and clinical outreach program, possibly beginning even before retirement, as a way to help improve the likelihood that retired NFL players will achieve a high quality of life after football,” Hipple says.

Researchers collected data about the most common problems experienced during the players’ retirement, with nearly half (48 percent) reporting that difficulty with pain was quite common or very common. Other problems included loss of fitness and lack of exercise (29 percent), weight gain (28 percent), trouble sleeping (28 percent), difficulty with aging (27 percent), and trouble with the transition to life after professional football (27 percent).

Schwenk notes that, because of these factors and others, the shift from being a professional athlete to retirement can be challenging. For players at the elite level in their sport, he says, their lives are fully organized around their performance, and they are given a great deal of support.

“On retirement, athletes have reported jarring transitions to a life in which the focus of such intense commitment is unclear, the resources and personnel that organized and managed their lives away from the competition venue are lost, and the rewards, both emotional and financial, are diminished,” Schwenk says.

Future studies should explore the hypothesis that the physical disabilities and chronic pain experienced by retired players cause significant difficulty with maintaining their fitness levels, making them more at risk for depression, the authors say.

The study was supported in part by a grant from the National Football League Players Association. The survey measured depression symptoms using the PHQ-9 questionnaire, which is based on standard diagnostic criteria. Participants also were asked about pain, nutrition, exercise, alcohol use and smoking, as well as other health issues.

In addition to Schwenk and Hipple, authors of the study were Daniel W. Gorenflo, Ph.D., research investigator in the Department of Family Medicine; and Richard R. Dopp, M.D., research fellow in the U-M Department of Psychiatry and a member of the Depression Center.